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Focus on Models & FORs

 

Models of Practice

 

Model of Practice vs Frame of Reference (FOR)

 

Model of Practice

Models of practice refers to the application of theory to occupational therapy practice. They can be thought of as “mental maps” that assist clinicians in understanding their practice. The main purpose is to facilitate the analysis of the occupational profile and to consider potential outcomes with selected interventions. This is achieved by bringing into focus the patient’s needs and abilities, contextual issues, and engagement in occupation. Models are not intervention protocols but instead serve as a means to view occupation through the lens of theory with the focus on the patient’s occupational performance. They aim to guide practice by providing a basis for decision-making. As occupation is the core of occupational therapy, they all deal with occupation in a central way- the commonality seen in each of the models is the focus on occupation.

Underlying models are 2 key approaches to facilitating occupational performance:
Remediation and Compensation.
* In a remediation approach, intervention is targeted towards improving performance components, with the assumption that such improvements will lead to enhanced occupational performance in the performance areas.
* A compensatory approach is used when remediation is not considered achievable or feasible. It “focuses on remaining abilities and aims to improve function by adapting or compensating for performance component deficits”. Examples of this approach include adapting the methods used to perform tasks, providing assistive devices, or modifying the environment.

Models should be applicable across settings and client groups instead of designed primarily for a specific diagnostic group.

 

Frame of Reference
The purpose of a frame of reference (FOR) is to help the clinician link theory to intervention strategies and to apply clinical reasoning to the chosen intervention methods. It is used to guide the intervention process. A FOR tends to have a narrower view of how to approach occupational performance when compared to models of practice.
The intervention strategies described within various FORs are not meant to be used as a protocol but rather offer the clinician a way to structure intervention and think about intervention progressions. The concept of “one size fits all” does not apply to the use of a FOR to guide intervention. That is why there is a need for multiple FORs to meet varied patient goals and outcomes. A clinician may need to blend intervention strategies from several FORs to effectively meet the patient’s needs.

 

MODELS

Models of practice aim to guide practice by providing a basis for decision-making. Because occupation is the core of occupational therapy, they all deal with occupation in a central way. The purpose of occupational performance is to be able to fulfil occupational roles.a

Occupational performance is defined as the ability to perform those tasks that make it possible to carry out occupational roles in a satisfying manner appropriate for the individual’s developmental stage, culture, and environment. Occupational roles develop in conjunction with the occupations in which people engage and include roles such as pre-schooler, student, parent, homemaker, employee, volunteer, or retired worker.

Occupational Adaptation (OA)
This model is based on the assumption that individuals desire mastery, environments demand it and the interaction between the two presses for it. It aims to provide a framework for conceptualizing the process by which humans respond adaptively to their environments. The focus of this model is on occupational adaptation rather than occupational performance. It distinguishes between the two concepts by conceptualizing occupational performance as a behavioral outcome and occupational adaptation as an internal process of generalization.
Occupational adaptation is viewed as a normal human process that occurs across the person’s lifespan, rather than something that only occurs when illness, stress or disability requires adaptation. Adaptation is defined as a change in one’s response to the environment when encountering an occupational challenge. Adaptation encompasses two important aspects: the need for a changed response and the idea of mastery.
Function and adaptation are not the same thing and that increased function does not necessarily mean increased adaptation. It is incorrect to assume that as the patient acquires more functional skills, or begins using assistive devices, adaptation is occurring. Function does not reflect the individual’s internal adaptation and it may remain unchanged. Occupational adaptation is a process that must occur internally, within the individual.
The model contains 3 elements: the person, the occupational environment, and their interaction.

1. Person
The person is conceptualized as consisting of unique sensorimotor, cognitive, and psychosocial systems, which are affected by biological, genetic, and phenomenological (experiences that we get from our senses, our consciousness…) influences and all of which are required for occupation.
This element can be viewed as the internal factors of the OA process. The desire for mastery over the environment is a constant factor in this process as it is always present – there is a constant demand for adaptation and mastery and this desire is innate in humans.

2. Occupational environment
This element can be viewed as the external factors that affect the person. The term occupational environment is used in this model to emphasize the link between mastery and occupation, in that, occupation is the vehicle through which people pursue mastery. Therefore, the term occupational environment is considered to represent the overall context within which the person engages in the particular occupation and occupational roles.

There are 3 types of occupational environments: work, play/leisure, and self-care. When using the model, it is essential for the clinician to understand the specific demands that the occupational environment places on the individual in order to be able to devise interventions that are appropriate to their occupational needs.

3. The interaction between the Person and Occupational environments
The third element of the OA process is the interaction between the internal and external factors, or person and occupational environments. The internal and external factors are seen as continuously interacting with each other through the modality of occupation. The desire for mastery (the person) and demand for mastery (occupational environment) combine to create the press for mastery.

 

Frames of Reference

Groups of FORs

– Biomechanical
– Rehabilitation
– Sensorimotor

 

Biomechanical- The understanding of kinematics and kinesiology serves as  the foundation for the biomechanical FOR. The clinician  views the limitations in occupational performance from a biomechanical perspective, analyzing the movement required to engage in the occupation. Based on principles of physics the requirements to perform a task or activity are assessed and serve as the basis for intervention.

Rehabilitation- This FOR focuses on the patient’s ability to return to the fullest physical, mental, social, vocational, and economic functioning as is possible. The emphasis is placed on the patient’s abilities and using the current abilities coupled with technology or equipment to accomplish occupational performance. Compensatory intervention strategies are often employed. Regardless of the technology or equipment available, the clinician must always link the intervention to the patient’s occupational performance.

Sensorimotor- Several FORs are included in this grouping, such as proprioceptive neuromuscular facilitation (PNF) and neurodevelopmental treatment (NDT) . These approaches share a common foundation of viewing a patient who has sustained a central nervous system insult to the upper motor neurons as having poorly regulated control of the lower motor neurons. To recapture the control of the lower motor neurons, various techniques are employed to promote reorganization of the sensory and motor cortices of the brain. The specific techniques vary but the basic premise is that when the patient receives systematic sensory information, his or her brain will reorganize and the return of motor function will be obtained.